Theory-Based Community Practice for HIV Prevention in Midlife and Older Women

ABSTRACT

In the last decade there has been a significant increase in HIV transmission among midlife and older women, particularly those from racial/ethnic minority communities. Although the number of women aged 50 and older diagnosed with HIV infection in the United States is increasing, they are rarely included in community HIV prevention strategies. This article presents integrating social capital with social justice themes into a socioecological framework for community practice that can significantly impact the efficacy of HIV prevention programs for midlife and older women. It also reviews the research and program implications for including midlife and older women in community interventions to halt the spread of HIV infection in this at-risk group. Suggestions for HIV prevention community practice with this underserved population are presented.     

Process evaluation of the ‘Singapore Physical Activity and Nutrition Study’

IntroductionThe Singapore Physical Activity and Nutrition Study (SPANS) aimed to improve the physical activity (PA) and nutrition behaviours of Singaporean women aged 50 years and over. The SPANS program consisted of PA classes, nutrition workshops, telephone dietary counselling, health booklets, a health calendar and program ambassadors. This study aimed to assess and understand the implementation of the program strategies and gain insight into process evaluation components to inform future programs.MethodsThe evaluation was guided by a process evaluation framework and collected data via questionnaires (n = 209), program ambassador documentation and exit interviews with program completers (n = 13) and non-completers (n = 12).ResultsIn total, 295 participants completed the program (response rate = 84 %). Participants reported high levels of satisfaction with the overall program (99.5 %) and program activities (96.7 %), and also rated program ambassadors highly. Participation rates were highest for telephone dietary counselling sessions. The main reason for not attending program activities was having a ‘busy schedule’ (n = 158). Participants cited a need for improved recreational centre facilities and increased flexibility around program delivery.ConclusionsThe process evaluation showed that the program strategies were implemented as planned and were deemed suitable for supporting behaviour change among Singaporean women aged 50 years and over. The program reached and involved the majority of participants throughout the six months. The combination of practical educational resources and supportive program ambassadors were key strategies that facilitated positive PA and dietary behaviours. However, there needs to be some flexibility in the delivery of programs. The findings of this research may inform other programs in the region.     

Combining Primary Prevention and Risk Reduction Approaches in Sexual Assault Protection Programming

Abstract

Objective: The object of this study is to extend prior evaluations of Elemental, a sexual assault protection program that combines primary prevention and risk reduction strategies within a single program. Participants and Methods: During 2012 and 2013, program group and control group students completed pretest, posttest, and 6-week and 6-month follow-up surveys assessing sexual attitudes and knowledge as well as experiences with assault. Results: The results reinforce previous findings that Elemental is effective in reducing sexual assault risk. Program effects were both direct, in that participation was associated with lower risk of assault, and mediated, in that participation impacted attitudes and beliefs that are empirically linked to risk of later assault. Conclusions: By combining both primary prevention and risk reduction approaches, Elemental is not only effective at reducing incidences of assault, it is also consistent with a number of recent recommendations for directions in sexual assault prevention programming.     

Working with Parents to Reduce Juvenile Sex Offender Recidivism

SUMMARY

Although there is very little research in the area of including parents in juvenile sex offender treatment, one of the factors that might be worth exploring is how the parental relationship may aid in successful relapse prevention. Since the family environment is a potential risk factor for adolescent sex offenders, integration of relapse prevention into daily family life may be a significant part of these youths' success or failure in the community. This article focuses on the concept of including parents in juvenile sex offender treatment. Issues addressed include what treatment providers can do to involve parents in relapse prevention, treatment providers' misconceptions about the inclusion of parents in treatment, a rationale for including parents in treatment, and research regarding different parenting styles.     

Student Drinking-Related Problems in an Urban Campus: Implications for Research and Prevention

Abstract

Objective: Researchers who study the etiology of college drinking typically employ measures of alcohol-use behaviors as outcomes; however, relatively little is known about the properties of alcohol-related problems (AP). This study aims to develop a single continuous measure of AP. Participants: The sample included 531 undergraduate college students who were surveyed in March 2007. Methods: The Rasch model was employed for dichotomous variables to analyze the measurement properties of 17 AP items. Results: Although issues with respect to differentiation at low levels of problem severity were identified, based on most strategies, the Rasch-based scale was shown to be a valid and reliable measure of AP among college students. Conclusions: Although there may be some need for slight modification and adjustment in the future, the AP scale developed here can potentially serve as a useful measure for etiological and prevention research.     

Development of a Questionnaire to Assess University Students’ Intentions to Use Behavioral Alcohol-Reduction Strategies

Abstract

Objective: To evaluate the psychometric properties of a new self-report questionnaire designed to assess college students’ intentions to employ 31 specific alcohol-reduction strategies. Method: Students attending a large public university were recruited to complete alcohol-reduction, drinking history, and personality questionnaires online. Results: Based on item–total correlations and principal components analysis, the authors eliminated 3 items and calculated average intention ratings across the remaining 28 items. The resulting scale had appropriate unidimensionality and excellent internal consistency. Correlations of intention questionnaire scores with measures of drinking history, alcohol outcome expectancies, sensation seeking, and impression management provided some support for criterion and discriminant validity of the questionnaire. Conclusion: This questionnaire could be employed as an outcome measure to evaluate prevention programs and as a clinical tool to identify clients who have little intention to employ drinking reduction strategies in heavy drinking situations.     

Cultural Factors and Program Implications

ABSTRACT

Despite the effectiveness of condoms in HIV prevention, programs and services encouraging HIV prevention have failed to increase condom use among U.S. Latino populations. The authors identify six “myths” preventing condom use among Latinos. It is suggested that programs address these myths surrounding condom use in HIV prevention strategies targeting Latino communities in order to make interventions more salient to Latino populations and, therefore, more effective.     

Suicide prevention on college campuses: What works and what are the existing gaps? A systematic review and meta-analysis

Abstract

Objective: To examine the effects of universal and targeted suicide prevention programs on relevant outcomes in college campuses. Methods: College suicide prevention programs published from 2009 to 2018 were assessed on outcomes including knowledge, skills, self-efficacy, suicidal ideation, and suicidal behaviors. Effects of the interventions on outcome variables with sufficient studies to warrant meta-analysis (ie, knowledge, skills, and self-efficacy) were meta-analyzed. Studies reporting on the remaining outcomes (ie, suicidal ideation and behaviors) were systematically reviewed. Results: Significant increases in suicide prevention knowledge, skills, and self-efficacy were observed in universal prevention interventions that typically employed gatekeeper prevention strategies. Evidence of reductions in suicidal ideation and behaviors was observed across targeted suicide prevention programs for at-risk students. Conclusion: Prevention programs are beneficial for training those likely to come in contact with people endorsing suicidality, but further research is needed to show that suicide interventions can consistently have significant effects on suicidal students as well.     

Trends in Alcohol Consumption Among Undergraduate Students at a Northeastern Public University, 2002–2008

Abstract

Objective: This study examined alcohol consumption patterns and trends at a public university in the Northeast from 2002 to 2008. Participants: Stratified random sampling was used to select undergraduate students enrolled in courses during spring semesters in 2002, 2004, 2006, and 2008. Methods: Data were collected during regularly scheduled classes for 4 measures of alcohol consumption and 5 demographic categories using the Core Alcohol and Drug Survey. Results: Four groups showed significant increases in both frequency and volume of alcohol consumption—students who were female, over 21 years of age or over, living off-campus, or performing well academically. There were no decreasing trends for any demographic group. These results differ from national college health surveys, which have shown alcohol use remaining steady during this period. Conclusions: Campus-specific trend data can provide unique perspectives and guide programming efforts. These trends suggest a need for new intervention strategies on this campus.     

Development & maintenance of social support among aged out foster youth who received independent living services: Results from the Multi-Site Evaluation of Foster Youth Programs

This study uses secondary data from the Multi-Site Evaluation of Foster Youth Programs, a randomized controlled trial of four independent living programs for youth in foster care. The subject of this investigation is the Life Skills Training Program (LST) of Los Angeles County, CA. We had three interrelated aims: (1) Evaluate the effectiveness of the LST program as compared to services as usual on the change in social support over time; (2) Examine the differences over time in social support by race and ethnicity among LST participants; and (3) Investigate the explanatory value of prosocial activities, educational involvement, current living arrangement, employment, victimization experiences, placement instability, and behavioral health symptomology on changes in social support over time among LST participants. We employed multilevel longitudinal modeling to estimate growth in social support over three time points (baseline, first follow-up, and second follow-up) among 482 youth (n = 234 LST; n = 248 control). We found a significant reduction in social support across the three time points. But, there was no difference in the social support trajectory between the LST and control groups. In addition, no racial/ethnic difference in the social support trajectory was detected. Results underscore the need to critically examine how independent living programming is intended to increase social support and whether modifying these practices can improve promotion and maintenance of social support for youth who age out of foster care.     

A Survey of 100 Community Colleges on Student Substance Use,Programming, and Collaborations

Abstract

Objective: The objective was to survey community college personnel about student substance use, and infrastructure (staff and funding), programs, and collaborations dedicated to substance use prevention. Participants: The sample included 100 administrators, faculty, and health services staff at 100 community colleges. Methods: Participants completed a Web-based survey. Results: Participants reported a number of alcohol and other drug (AOD) related concerns. Despite limited staff and funding dedicated to AOD, institutions are implementing a number of programs, although many are not implementing some of the programs popular at traditional 4-year colleges. They are also collaborating with a number of on- and off-campus groups. The availability of staff and funding dedicated to AOD, and the presence of residence halls, is associated with health programming and substance abuse collaborations. Conclusions: Results suggest that there is a need for increased research to understand the most effective AOD prevention strategies for community colleges.     

Using social media-based drama therapy and family counselling to treat symptoms of postpartum depression among women

This study examines the impact of social media-based drama therapy and family counselling in reducing symptoms of postpartum depression (PPD) in women aged 18–34. The researchers used a quasi-experimental design and randomly assigned the participants (n = 303) to the control, drama therapy, and family counselling groups. The key findings of the study are as follows. First, at baseline, women not only showed more symptoms of PPD than their male counterparts, but men also reached the PPD threshold of 12/13. Second, the difference between women and men regarding their PPD scores achieved statistical significance (p = 0.004). However, during the post-intervention assessment, men who received drama therapy intervention reported a significant drop in their PPD below the threshold of 12/13. Only women whose spouses received family counselling on spousal support reported a significant drop in their PPD. However, those whose partners did not receive family counselling on spousal support still reported PPD scores within the threshold. In both instances, women in the control group still had high PPD scores. Finally, during the 6-month follow-up assessment, even men in the control group did not have significant symptoms of PPD as their scores dropped below the threshold. On the contrary, women in the control group still had high PPD, indicating that PPD lasted more in women than in men. Also, women whose husbands received family counselling on spousal support reported PPD scores below the threshold. However, women whose husbands did not receive spousal counselling still had PPD scores at the threshold, even though their scores marginally dropped.     

A program based on Social Cognitive Theory and Smith's model of health and illness and its effect on maternal self-efficacy and child behavior

PurposeThis study was conducted in order to determine the effect of a program based on Social Cognitive Theory and Smith's Model of Health and Illness on the self-efficacy, self-esteem and attitudes of mothers and on the emotional and behavioral problems and competence levels of their children.MethodThis quasi-experimental study used a control group and a pretest-posttest design. The sample was composed of 77 mothers (experimental group, n = 39; control group, n = 38) who had low self-efficacy and self-esteem and whose children had problematic behavior. The mothers in the experimental group underwent a 10-session program over a period of 10 weeks. This program included activities to help them build trust in themselves and their surroundings, induce positive thinking, increase their childcare knowledge and skills, establish an effective interaction with their children, set realistic and positive goals, cope with stress, experience the feeling of success and become motivated. Data were collected by using the Demographic Information Form, the self-efficacy for Parenting Task Index-Toddler Scale, the Rosenberg Self-Esteem Scale, the Parent Attitude Scale and the Brief Infant-Toddler Social & Emotional Assessment. Data were collected before the start of the program, immediately after its completion and three months afterwards.ResultsIt was found that, at the end of the program and after the following three months, the self-efficacy, self-esteem and democratic attitude scores of the experimental group mothers and the competency scores of their children had significantly increased compared to their pre-program scores. The problem domain scores of their children had decreased and a statistically significant difference was detected in favor of the experimental group. In both the experimental and the control group, a weak negative correlation was found between the self-efficacy and democratic attitude scores of the mothers and the problem domain scores of their children.ConclusionThe total 12-hour program created a positive change, even among the mothers with low self-efficacy, low self-esteem and low education and income levels who had problematic children. Therefore, healthcare professionals may find it beneficial to offer this program to all mothers having 2- and 3-year-old children.     

Keynote Address: Impact of the Future on College Health

Abstract

Objective: The authors investigated the effect of gain-framed (GF) compared with loss-framed (LF) messages on exercise behaviors in normal weight and among overweight/class I obese. The authors also examined which groups would have significantly improved exercise behaviors over time. Participants: Sixty-four undergraduates were randomized to the 4 groups by message type and weight category from September 2008 to December 2011. Methods: After screening, students received messages and attended an exercise instruction session. Results: There were no significant differences between GF or LF message groups among normal weight or overweight/obese on the primary outcomes at posttest. After receiving the GF messages, the overweight/obese group was the only group to have a significant increase on all 3 primary outcomes: fitness center attendance (p = .038), combined moderate- and vigorous-intensity activity (p = .005), and strength training (p = .037). Conclusions: The exercise behaviors of undergraduate students who are overweight or obese can benefit from GF messages.     

Cigarette Smoking Among Korean International College Students in the United States

Abstract

Objective and Participants: This study explored (1) the prevalence of cigarette smoking among South Korean international college students in the United States, (2) differences in smoking between on- and off-campus living arrangements, and (3) predictors of an increase in smoking over time in the United States Methods: An online survey was completed by 1,201 students at 52 4-year US universities (34% response rate). Results: The overall smoking prevalence was 43.5%. The smoking rate (29.0%) of female students was higher than that (4%) of female college students in South Korea. Sex, living place, living situation, length of stay as a student in the United States, home smoking rules, campus-wide tobacco-free policies, and levels of acculturative stress, anxiety, and depression were significantly associated with an increase in smoking (p < .05). Conclusions: Given the high smoking prevalence among the South Korean students on US college campuses, targeted prevention efforts for these students may be warranted.     

Oral Cancer Risk Behaviors Among Indiana College Students: A Formative Research Study

Objectives: In fall 2004, the authors used a survey to assess the knowledge, attitudes, motivations, and behaviors of college students relative to oral cancer prevention to inform development of targeted prevention programming. Participants: A convenience sample of 1,003 undergraduate students at one public university in Indiana participated. Methods: Discriminant function analysis was employed to analyze participants' motivations; perceived risks; individuals who influence participants' alcohol, tobacco, and marijuana use; and factors that facilitate and discourage use. The study sample was divided into users and nonusers to differentiate between groups and predictor (discriminating) variables. Multiple regression analysis was used to determine the extent to which participants' knowledge, attitudes, peer perceptions, sex, age, and ethnicity contributed to participants' combined alcohol, tobacco, and marijuana use behaviors. Results: With 2 exceptions, discriminant function analysis (p < .01) correctly categorized user status (ie, nonusers vs combined users of alcohol and cigarettes; nonusers vs combined users of alcohol, cigarettes, and marijuana) by the predictor variables. Multiple regression analysis to determine whether independent variables predicted combined drug use generated significant (p < .01) results across all combined use behaviors. Conclusions: Multiple oral cancer prevention program options along with additional formative research efforts were suggested by study results.     

Implications for Sexual Assault Prevention: College Students as Prosocial Bystanders

Abstract

Prosocial bystander interventions are promising approaches to sexual assault prevention on college campuses. Objective: To assess bystander attitudes among undergraduate students at a northeastern university. Participants: A convenience sample of 188 students from 4 undergraduate classes was surveyed during regularly scheduled class sessions. Methods: Participants completed a short survey on bystander efficacy, readiness to change, and barriers to intervention prior to the start of class. Results: The majority of students were not involved in activities or programs focused on sexual assault prevention. Although students agreed that violence could be prevented, they perceived many barriers to their own participation in intervention. Conclusions: There is a need for gender-targeted prevention programming that introduces the idea of prosocial bystander intervention, with a focus on increasing self-efficacy and lowering barriers.     

Comparing the effectiveness of individual and group therapy for students with symptoms of anxiety and depression: A randomized pilot study

Abstract

Objective: To examine the effectiveness of individual versus group therapy for anxiety and depression among university students. Participants: Forty-one university students experiencing moderate to severe symptoms of anxiety and/or depression participated during one of three academic semesters from 2015 to 2016. Methods: Participants were randomly assigned to either 6-weeks of individual or group therapy and completed outcome measures at pre-and-post-treatment. Results: Significant reductions in both depression and anxiety scores were found across time, with no significant difference between group and individual therapy outcomes. Exploratory analysis of attitudes toward therapy found that while individual therapy was rated more favorably than group therapy overall, attitudes toward therapy became more favorable from pre to post-treatment for all participants. An interaction showed differences in attitudes toward individual and group therapy according to participants’ randomly assigned treatment. Conclusions: These findings support the increased usage of group therapy within university counseling centers, with implications for stepped care discussed.     

Life Change and Spirituality Among a College Student Cohort

Objective: Because college marks a time when life-change is typically high, the authors designed this study to determine whether life-change was related to degree of spirituality, the "directing" component of health, among a college student cohort. Participants and Methods: The sample group, consisting of 180 northeastern US undergraduate college students, completed the 48-item Life Attitude Profile-Revised (LAP-R) and the Schedule of Recent Experience (SRE) in the fall semester of 2004. Results: Findings indicate that college students who reported experiencing higher levels of life change, both positive and negative, also scored lower on spirituality. Nevertheless, these students had scores indicative of a higher desire to find spirituality, even though their motivation to do so was low. Conclusions: Although life changes among college students likely will remain high, lower spirituality can be enhanced; therefore, interested health educators are encouraged to help students increase their degree of spirituality.     

Evaluation of a Resilience Intervention to Enhance Coping Strategies and Protective Factors and Decrease Symptomatology

Objective: In this pilot study, the authors examined the effectiveness of a 4-week resilience intervention to enhance resilience, coping strategies, and protective factors, as well as decrease symptomatology during a period of increased academic stress. Participants and Methods: College students were randomly assigned to experimental (n = 30) and wait-list control (n = 27) groups. The experimental group received a psychoeducational intervention in 4 two-hour weekly sessions. Measures of resilience, coping strategies, protective factors, and symptomatology were administered pre- and postintervention to both groups. Results: Analyses indicated that the experimental group had significantly higher resilience scores, more effective coping strategies (ie, higher problem solving, lower avoidant), higher scores on protective factors (ie, positive affect, self-esteem, self-leadership), and lower scores on symptomatology (ie, depressive symptoms, negative affect, perceived stress) postintervention than did the wait-list control group. Conclusions: These findings indicate that this resilience program may be useful as a stress-management and stress-prevention intervention for college students.